Evaluating the impact of remote care in sexual and reproductive health services on outcomes and health inequalities in the UK: a retrospective observational study of routine service-level data.

INTRODUCTION: Remote clinical consultations and online postal self-sampling are increasingly established components of sexual and reproductive healthcare provision in the UK. However, there are concerns that uptake and outcomes of remote healthcare may differ by demographic groups and so increase health inequalities. METHODS: We conducted a retrospective analysis of service-level data within two case study areas (CSAs) in England and one in Wales. Primary outcomes were treatment within 6 weeks among chlamydia cases and uptake of long-acting reversible contraception (LARC) among women attending for contraceptive care. Outcomes were compared between 2019 and 2022, during which remote care use increased in all CSAs. We evaluated overall change within each CSA, and whether changes differed by age, gender and sexual behaviour, ethnicity and Index of Multiple Deprivation (IMD). RESULTS: Analyses included 446 819 individuals across 2019-2022. Comparing 2019 to 2022, there was a small reduction in chlamydia treatment success in CSA-A (relative risk (RR) 0.95, 95% CI 0.93 to 0.98) and small increases in CSA-B (1.12, 1.10 to 1.14) and CSA-C (1.07, 1.03 to 1.12). Changes did not significantly vary by ethnicity or IMD, but treatment success dropped for men who have sex exclusively with women in CSA-A (RR 0.88 vs 0.98 in women) and increased for 16-34 year-olds in CSA-B (p=0.001 across groups). LARC uptake decreased in CSA-A (RR 0.58, 95% CI 0.55 to 0.60) but increased in CSA-B (1.18, 1.15 to 1.21) and CSA-C (1.06, 1.01 to 1.11) as proportion of contraceptive care episodes, although total LARC fittings fell in all CSAs; reduction was greater in women aged 35-49 in CSA-A (p<0.001) and increase was greater in women 16-34 in CSA-B (p<0.001). There was limited evidence for differences by ethnicity or IMD. CONCLUSIONS: The study areas varied in their implementation of remote care and healthcare outcomes, but we found no strong evidence that changes in provision of remote care were associated with increases in health inequity.